Support Needs Questionnaire

Transcription

1 Support Needs Questionnaire Version 2.3: February 2011 Name: Address: This questionnaire is for you to complete with the social worker from Newcastle City Council Adult and Culture Services. You will already have had a Community Care Assessment that has shown that you have needs that the Council can help you with; these are called eligible needs. The questionnaire is about different parts of your life that you might need some support with because of your disability or illness. It covers the kinds of needs that the Council is currently able to provide support with. When we talk about support, we mean things like: Someone doing something for you Someone helping you to do things for yourself Someone helping you to keep safe and well Someone encouraging you or reminding you to do things How do I complete the questionnaire? The questionnaire will be completed by your social worker, with you and the people who are important to you. We will usually give you a copy in advance so you have an idea of what to expect. You can start to fill it in yourself or talk it over with family or friends first, but you don t have to. If you want to start filling it in yourself, this is what you need to do: Read each section, and tick the box that best describes you and your circumstances If you already get help from someone you need to answer the questions as if you didn t get any help; this gives us a better idea of what your actual needs are 1

2 Don t worry if you don t know how to answer any of the questions, because your social worker will go through it with you so that we can reach an agreement about which statements match your needs. Each of your answers will then be given a point score. The number of points will give us an idea of your overall level of need and this will equal an amount of money to buy support to meet your needs. Your social worker will then ask about the amount of help you get from family or friends there are some questions in each section about them and their circumstances too. We call people who give you help without getting paid for it informal carers. There are some extra questions that your social worker will need to ask your carer about. We ask these questions because the Council cannot replace all of the care you get from your family and friends, but we do want to make sure that the support we provide helps them in looking after you. We also want to check that they are willing and able to carry on and are not putting their own health and well-being at risk, struggling to stay in employment or think their own personal lives are affected as a result of their caring responsibilities. We will also ask you about your own finances because you might have to make a contribution towards the cost of your support. What happens next? Once you, your carer and your social worker have finished completing the questionnaire and you have had a financial assessment we will be able to tell you how much funding will be available to help meet your needs. This is called your Personal Budget. You will need a written Support Plan which will explain how you want to use your Personal Budget and how you will get the support you want. We need to make sure that your Personal Budget is spent on meeting your needs, so your support plan will have to be approved by the Council. You can choose to write your support plan on your own or with the help of your family or other people you trust. However you choose to do it, your social worker will help you with it if you want them to. 2

3 These are free or low-cost things that we will always offer to do for you if you need it. Tick if you think that this is needed: Refer you to our Welfare Rights Service to make sure you are getting all the benefits you are entitled to. Refer you to our Equipment Direct Team, to look at whether or not small pieces of equipment or minor adaptations to your home would help you to be more independent. Refer you to our Sensory Support Team if you have sight or hearing difficulties to check whether there is any equipment or support available that will assist you to maintain your independence. Refer you to services that the Council provides to help you to be more independent with getting around in the home or outside, or looking after yourself. Help you to check if you are entitled to concessionary travel and apply for it. Refer you to, or give you information about, services provided by the NHS that might help you to stay well, including a dentist. Refer you to services that can provide free or low cost equipment to help you to keep safe like alarms that automatically alert others if you fall. This sort of equipment is known as Telecare. Refer you to services that might be able to help you and your home to stay warm in the winter. Give you information and advice about leisure services that you can use in the city, and check if you are entitled to concessions. Tell you where you can get information and advice about other things that you say matter to you. Give you help if you are being harmed by someone else. We call this Safeguarding Adults. 3

4 1. Support with personal care in the home Personal care means the help that you need to get out of bed, get washed, clean your teeth, dress and undress and use the toilet. It also includes helping you to eat or drink. Personal care isn t just about physical assistance it might mean that you need help from someone else to prompt you to do things in the right order, remember to do them at all or to do them safely. Why do we want to help you with personal care needs? Newcastle City Council is committed to people getting the right help if they have personal care needs. So, we can assist you to achieve the following outcomes: You are clean and comfortable, and dressed and groomed in a way that suits you. You will stay as well as possible because you will get enough to eat and drink. Your dignity will be maintained. You won t get ill or less able because you struggle with personal care. Now, choose the statement on the next page that best describes the help you need with personal care in the home 4

5 1. Support with personal care in the home A: I am able to carry out my personal care and don t require any support in this area. B: I am able to carry out my personal care with just small amounts of physical help or prompts from someone else. C: I need a lot of support from another person to carry out my personal care. D: I am unable to carry out any of my personal care by myself. Further Action Consider referral to Equipment Direct or Sensory Support Team. Consider referral to Equipment Direct, Occupational Therapy or Sensory Support Team. Complete checklist to screen for NHS Continuing Health Care Assessment. Complete checklist to refer for NHS Continuing Health Care Assessment. What help do you get from informal carers now with personal care in the home? By informal carers we mean family, friends or neighbours who don t get paid to look after you. Please tick whichever applies: Your social worker needs to talk to your informal carer(s) about these next questions: Are you willing and able to continue giving this level of help? YES NO N/A What level of help can you continue to give from now on? Please tick whichever applies: Is there anything else you want to say about your support needs in this section? 5

6 2. Support with being part of your community This part is about the support you may need to do things in your community, like spending time with your friends, going to the cinema or the social club, going to the shops, the library or just making use of your spare time. You might want to get involved in local organisations or do voluntary work or you might want to do an evening class or go to college. It is also about the support you may need if you are thinking of getting a job and need to prepare for work or to stay in employment. Why do we want to help you to be part of your community? Newcastle City Council is committed to people being an active part of life in the city. So, we can assist you to achieve the following outcomes: You will be involved and included in your community as much as you want to be. You will have the opportunity to make a positive contribution in a variety of different ways. You will remain in employment for as long as possible. Now, choose the statement on the next page that best describes the help you need to be part of the community 6

7 2. Support with being part of your community A: I don t require any support in this area. Further Action B: I need some support to do the things I want in the community because I am less independent than I used to be. C: I need support to do more in the community because I am not able to get out easily by myself. D: I need someone to support me closely to get involved in the community where I live; I can t do this by myself because I find it difficult to deal with other people or I need a lot of help with personal care when I am out and about. E: I need support to help me get a job. F: I need support to remain in work or return to work after injury or ill health. Refer to Work First, or other relevant employment support provider Refer to Jobcentreplus for Access to Work funding. What help do you get from informal carers now with being part of your community? By informal carers we mean family, friends or neighbours who don t get paid to look after you. Please tick whichever applies: Your social worker needs to talk your informal carer(s) about these next questions: Are you willing and able to continue giving this level of help? YES NO N/A What level of help can you continue to give from now on? Please tick whichever applies: Is there anything else you want to say about your support needs in this section? 7

8 3. Looking after yourself and staying safe in the community This section is about the support that you need to stay living safely in your own community, both inside and outside your home. It covers the help you need so that you don t neglect your mental or physical health or the things you need to do to stay living in your home. Examples include managing bills, money or medicine, essential food shopping, preparing a meal and domestic tasks that are critical to keeping your home clean and safe. This section also covers help you need to be protected from other people who might exploit, harm or neglect you or try to limit your choices unfairly. Why do we want to help you stay healthy, safe and as independent as possible? Newcastle City Council is committed to people being able to live the way they want to and be free from harm. So, we can assist you to achieve the following outcomes: You will continue to live in the community, be as safe and well as possible and not be harmed by anyone else. You will stay as healthy as possible. You will be able to think about what you want and not be rushed or pushed into doing things you don t want to do. You will make decisions about things that are important to you, but if you can t, others will always make decisions for you that are in your best interests. Now, choose which statement on the next page best describes the help you need to look after yourself and stay safe 8

9 3. Looking after yourself and staying safe in the community A: This section is not relevant to me as I am able to keep safe and well without support. B: I need some help at least once a week to stay safe and well. C: I need some help at least once a day to stay safe and well. D: I cannot be left alone for very long and need help regularly throughout the day to stay safe and well. Further Action Referral to Welfare Rights or Money Matters. Referral to Tenancy Support Officer. Referral to Welfare Rights or Money Matters. Consider Telecare. Referral to Tenancy Support Officer. Mental Capacity Act assessment may be required. Mental Capacity Act assessment may be required. Complete checklist to screen for NHS Continuing Health Care Assessment. What help do you get from informal carers now with looking after yourself and staying safe in the community? By informal carers we mean family, friends or neighbours who don t get paid to look after you. Please tick whichever applies: Your social worker needs to talk to your informal carer(s) about these next questions: Are you willing and able to continue giving this level of help? YES NO N/A What level of help can you continue to give from now on? Please tick whichever applies: Is there anything else you want to say about your support needs in this section? 9

10 4. Dealing with risky behaviour This section is about the support that you need to help you to deal with things that you do that might create danger for you or other people. The things you do might be risky because you forget or because you find it hard to understand how what you do affects others. It might mean help coping with problems caused by you not realising that you need help with something and trying to do it yourself. It might mean dealing with the consequences of getting angry very quickly or becoming very anxious. It is different from the last section because it is about things you actively do that could cause harm. Why do we want to help you stay safe and keep others safe? Newcastle City Council is committed to keeping people in the city safe and supporting people to do the things they want to do as long as they don t harm others. So, we can assist you to achieve the following outcome: You will be as safe and independent as possible and nobody else will get hurt because of the things you might do. Now, choose which statement on the next page best describes the help you need with dealing with risky behaviour 10

11 4. Dealing with risky behaviour A: This section is not relevant to me as the things I do don t cause problems for me or anyone else. Further Action B: Other people have a problem with some things that I do. I need some support to manage this so that there is no real danger for me or other people. C: I do not know when I am in a situation where I can be hurt or hurt others. As a result of my needs and the risks that the things I do may pose to myself or others I need support a lot of the time. D: As a result of my significant needs and the risks that my behaviour may pose to myself or others, I need at least one person with me most or all of the time. Mental Capacity Act assessment may be required. Complete checklist to screen for NHS Continuing Health Care Assessment. Mental Capacity Act assessment and Best Interests Decision required. Refer for advocacy. Complete checklist to refer for NHS Continuing Health Care Assessment What help do you get from informal carers now with dealing with risky behaviour? By informal carers we mean family, friends or neighbours who don t get paid to look after you. Please tick whichever applies: Your social worker needs to talk to your informal carer(s) about these next questions: Are you willing and able to continue giving this level of help? YES NO N/A What level of help can you continue to give in the future? Please tick whichever applies: Is there anything else you want to say about your support needs in this section? 11

12 Are you a parent or carer? Newcastle City Council recognises that people who need help themselves, because they are disabled or experiencing physical or mental health problems, sometimes look after other people too. You might have children or you might look after another adult. We want to help you to be a parent or carer so that: You will be able to continue being a parent or carer for your children You will be able to continue to look after an adult who is close to you, or the adult you look after will get support from someone else If you have children they won t have to provide any help that is inappropriate to their age Do you look after someone else? (please tick) Yes No If yes, who do you look after? These are some of the things that we will always do if you look after someone else: Refer the adult who needs help from you for a Community Care Assessment of their own. Ask you about the kind of help you might need to be a parent. Refer you to the Carers Centre, if you want us to. The Carers Centre is an independent organisation that gives advice about what help carers might be entitled to, emotional support and information about community activities with other people who are carers. Make a referral to the Young Carers Service, if you or the young person wants us to. The Young Carers Service is an independent organisation that works with children and young people who have caring responsibilities. The Young Carers Service gives emotional support, can help young people say what they think about their situation and can help them get involved in activities that are just for them. 12

13 You have now answered all the sections in the Support Needs Questionnaire. There are a few more things that we need to ask you: Support you get from other people: Is there anyone who helps you on a regular basis and is not paid to do so by you or anyone else? (please tick) Yes No Is anyone who gives you some support aged under 18? Yes No We will talk to you more about this because young carers may have extra needs. The last section is for your main carer to complete: Main Carer s Permissions Newcastle City Council is committed to helping carers look after people they are close to. By carers, we mean people who provide different kinds of unpaid support (not just physical care) to family, partners or friends who are in need of help because they are ill, frail, have a disability, mental health needs or a drug and alcohol problem. By allowing us to keep an electronic copy of your details, we are able to: match you to the person you care for and know who to contact in case of an emergency; collect general information about people who are carers in Newcastle; this helps us to keep on doing what we do well, and get better when we need to improve; include your contact details on the assessment and care plan of the person you look after, so that we can let other people who are involved in supporting them (like a care agency or G.P.) that there is a carer involved. In accordance with The Data Protection Act 1998, we won t share your personal details outside the Council for any other reason without your permission. The only time Newcastle City Council will share information without your consent is if it is necessary to prevent harm to children or vulnerable adults or to prevent / report serious crime. If you agree to us keeping an electronic copy of your details, please complete the next section: 13

14 Do you agree to the Council keeping a record of your personal details as the main carer for the person you look after? (please tick) Yes No If yes, please tell us your: Name: Address: Contact number: Date of Birth: Ethnicity: Signed: We ask this because we want to know the age and ethnic background of carers in Newcastle, to make sure the support we offer is right for everyone. Signed by parent or guardian if you are under 16: Remember you can have an assessment of your own needs, without the person you look after. We call this a Carers Assessment. Ask the social worker who completes this questionnaire with you for more information. Self-Directed Support your life, your choice! 14